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27 Jan 2010 : Column 910

The Minister would be surprised if I did not mention out-of-hours dentistry, which is in crisis-dentistry is in crisis during the day and at night. If the Minister went to A and E units at night and talked to patients, he would find a huge number who are there simply because they cannot get a dentist during the day. We know that in excess of 1 million patients cannot access NHS dentistry, but when people are in pain and turn up at A and E, we need to ensure that the skill base is available for them.

My hon. Friend the Member for Basingstoke (Mrs. Miller) mentioned walk-in centres integrating with A and E. I have seen that in action and it absolutely works around the country and releases a lot of the pressure from existing A and E units. I am sure all hon. Members visit their A and E units-I am lucky enough to go and visit very many. Many patients could have been seen at a minor injuries unit, but they go to the A and E because they feel safe. Many in A and E wanted to get a GP appointment but could not, and many are sent to A and E after a long call to NHS Direct, when they could have been triaged in a much better way.

Working as an integrated service is crucial if we are to have the out-of-hours and urgent care that we need. The Government disagree with our policies-that is their prerogative-but they should call an election and let the public decide.

6.49 pm

The Parliamentary Under-Secretary of State for Health (Ann Keen): I too wish to say how well this debate has gone. There have been improvements in out-of-hours services in the last 12 years. They are good, but they are not great. They have let some people down and we need to improve them further. That is why we have asked Professor Steve Field, the chairman of the Royal College of General Practitioners, and Dr. David Colin-Thomé, the director of primary care services in England, to review the out-of-hours service. The report by the Quality Care Commission will also be presented shortly. We have more work to do on out-of-hours services and we intend to improve them. We need to ensure that PCTs and employers do the checks that are needed.

The hon. Member for North Norfolk (Norman Lamb) said that he wanted to see checks on language and professional competence, and that those should be carried out by the GMC. He claimed that that would require changes to the EU directive. We cannot wait that long. The issues need to be addressed now. PCTs have a legal responsibility to ensure competence in the English language and the practice of medicine. Employers should also have that responsibility, and we need to ensure that that is done. Reform of the EU directive is not necessary to achieve that.

My right hon. Friend the Member for Rother Valley (Mr. Barron) chairs the Health Committee and is well known for his detailed opinions on health. I shall address his points throughout my speech. As my hon. Friend the Member for Dartford (Dr. Stoate) said, with obvious authority, responsibility for out-of-hours services lies with the PCT. The hon. Member for Boston and Skegness (Mark Simmonds) says that he would transfer responsibility for commissioning of out-of-hours services to GPs. They would therefore be liable in law for any failures by locums they employ, or any negligence or failures by an
27 Jan 2010 : Column 911
employed GP. It is no wonder that the BMA is concerned about Conservative policy, which would lay a similar liability on GPs to that which they had before 2004.

My hon. Friend the Member for South Derbyshire (Mr. Todd) spoke movingly about the care of long-term conditions. Such conditions require a different out-of-hours service. In many instances, they require a rapid response team, and many such teams are in place. They are multi-disciplinary, including paramedics and specialist nurses. The hon. Members for Basingstoke (Mrs. Miller) and for Beckenham (Mrs. Lait) also spoke of the need for health care teams with different skills, including physiotherapists, paramedics and nurses.

Martin Salter (Reading, West) (Lab): My hon. Friend mentions nursing. I am interested in the development of policy in that area. Does she intend to follow the Leader of the Opposition and meet the Nurses for Reform campaign group which advocates the wholesale privatisation of the NHS, including out-of-hours care?

Ann Keen: My hon. Friend raises an important point. I wonder whether Opposition Front Benchers have met that group- [ Interruption. ] Have you met them? [ Interruption. ]

Mr. Deputy Speaker: Order. I have not met anyone.

Ann Keen: From what I have read of that group, my hon. Friend's remarks are very worrying.

The hon. Member for Wyre Forest (Dr. Taylor) spoke of the 111 system, which will be excellent. I am pleased to see that the pilots may be ready as early as May or June. He made a point about the BMA involving GPs in commissioning, but I would go further and look for more nursing staff to be involved in the commissioning of services.

As usual, the comments by the hon. Member for Mid-Bedfordshire (Nadine Dorries) did not disappoint me.

I thank all hon. Members who contributed to this debate and I know that they would want to thank NHS staff. Illness, accidents and ailments pay no attention to the time of day, so we must do all that we can to ensure that patients get the right treatment, at the right time and in the right place, and we must have a system of out-of-hours and urgent care that is achieving that goal. People can now access the NHS in more ways than ever before: through one of the 112 new GP surgeries in the areas with the fewest doctors and the greatest need, and through the new GP-led health centres, of which there is one in every primary care trust, open from 8 am until 8 pm, seven days a week, 365 days a year-there is an excellent one up and running in the heart of Hounslow, and the treatment for my constituents is second to none. People can also access the NHS through local pharmacies, some of which are now open seven days a week and into the night; through minor injuries units and urgent care centres, many of which are nurse-led; and through NHS Direct, either over the phone or online. With so many options to choose from, it is important to give patients and local communities the information to get the help that they need.

The hon. Members for North-East Cambridgeshire (Mr. Moss) and for North Norfolk talked about the patient, Mr. David Gray. Many have expressed their
27 Jan 2010 : Column 912
concern and sympathy about that case, and I would like to align myself with that and with the dignity shown by the hon. Member for North-East Cambridgeshire.

We owe the NHS a great tribute, but we also owe our patients and constituents right and safe care, whether in respect of long-term conditions or urgent dental treatment-many of our dental practices also operate out-of-hours services. Many dentists should be commended for their work rather than constantly criticised for a lack of commitment. They want to contribute to primary care in every way possible by being at the heart of our communities, and many want to, and will, work in the walk-in centres of the future. We are encouraged by the people who work in the NHS and, in particular, by how people want to work in communities. It has been difficult to correct the out-of-hours service, which before 2004 was not effective, but equally the schemes now in place will need the review to be led by Professor Stephen Field. When he reports back, which should be soon, I believe that we will act on it.

We have said that we will address the areas of change in relation to the European rulings, and that we will look at commissioning, because that is key to providing the correct services for all patients. Any GP working for out-of-hours providers is subject to the same checks as all other doctors working in general practice in England. Employers have a duty to ensure that all the doctors whom they employ are suitable for the provision of the services that they are employed to provide, and all doctors, including locums, must be on a PCT's performers list before they can provide primary medical services.

Concerns about individual doctors can be investigated by the GMC, which can, when justified, remove a doctor from the medical register on fitness-to-practise grounds. All our services must be safe and of a high quality. They will be checked by the Care Quality Commission or the other regulators that will be needed. When I look at the extension of patient services since the resources that have been put into the health service, I feel confident that we will continue to improve our practices in every way possible for our constituents, and that is thanks to NHS staff and the commitment that they show.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

The House divided: Ayes 176, Noes 267.
Division No. 64]
[6.59 pm


Afriyie, Adam
Ainsworth, Mr. Peter
Amess, Mr. David
Ancram, rh Mr. Michael
Arbuthnot, rh Mr. James
Atkinson, Mr. Peter
Bacon, Mr. Richard
Baker, Norman
Baldry, Tony
Baron, Mr. John
Beith, rh Sir Alan
Bellingham, Mr. Henry
Benyon, Mr. Richard
Beresford, Sir Paul
Binley, Mr. Brian
Blunt, Mr. Crispin
Bone, Mr. Peter
Brady, Mr. Graham
Brazier, Mr. Julian
Brooke, Annette
Browne, Mr. Jeremy
Browning, Angela
Burns, Mr. Simon
Burt, Alistair
Cable, Dr. Vincent
Carswell, Mr. Douglas
Cash, Mr. William
Chope, Mr. Christopher
Clark, Greg
Clarke, rh Mr. Kenneth
Clifton-Brown, Mr. Geoffrey
Cox, Mr. Geoffrey
Curry, rh Mr. David

Davies, David T.C. (Monmouth)
Davies, Philip
Davis, rh David
Djanogly, Mr. Jonathan
Donaldson, rh Mr. Jeffrey M.
Dorrell, rh Mr. Stephen
Dorries, Nadine
Duddridge, James
Duncan, Alan
Evennett, Mr. David
Fabricant, Michael
Fallon, Mr. Michael
Field, Mr. Mark
Foster, Mr. Don
Fox, Dr. Liam
Francois, Mr. Mark
Gale, Mr. Roger
Garnier, Mr. Edward
George, Andrew
Gibb, Mr. Nick
Gillan, Mrs. Cheryl
Goodman, Mr. Paul
Goodwill, Mr. Robert
Gray, Mr. James
Green, Damian
Greening, Justine
Grieve, Mr. Dominic
Gummer, rh Mr. John
Hammond, Stephen
Hands, Mr. Greg
Harper, Mr. Mark
Harvey, Nick
Hayes, Mr. John
Heathcoat-Amory, rh Mr. David
Hemming, John
Hendry, Charles
Herbert, Nick
Hoban, Mr. Mark
Hollobone, Mr. Philip
Holloway, Mr. Adam
Horam, Mr. John
Howard, rh Mr. Michael
Howarth, Mr. Gerald
Howell, John
Huhne, Chris
Hunter, Mark
Hurd, Mr. Nick
Jack, rh Mr. Michael
Jackson, Mr. Stewart
Jenkin, Mr. Bernard
Jones, Mr. David
Kawczynski, Daniel
Keetch, Mr. Paul
Key, Robert
Kirkbride, Miss Julie
Knight, rh Mr. Greg
Kramer, Susan
Laing, Mrs. Eleanor
Lait, Mrs. Jacqui
Lamb, Norman
Lancaster, Mr. Mark
Lansley, Mr. Andrew
Leech, Mr. John
Leigh, Mr. Edward
Letwin, rh Mr. Oliver
Lewis, Dr. Julian
Liddell-Grainger, Mr. Ian
Luff, Peter
Mackay, rh Mr. Andrew
Maclean, rh David
Maples, Mr. John
McIntosh, Miss Anne
McLoughlin, rh Mr. Patrick
Mercer, Patrick
Miller, Mrs. Maria
Milton, Anne
Moss, Mr. Malcolm
Mulholland, Greg
Murrison, Dr. Andrew
Newmark, Mr. Brooks
O'Brien, Mr. Stephen
Ottaway, Richard
Paice, Mr. James
Pelling, Mr. Andrew
Penning, Mike
Penrose, John
Pickles, Mr. Eric
Prisk, Mr. Mark
Pritchard, Mark
Pugh, Dr. John
Randall, Mr. John
Redwood, rh Mr. John
Rennie, Willie
Rifkind, rh Sir Malcolm
Robathan, Mr. Andrew
Robertson, Hugh
Robertson, Mr. Laurence
Rogerson, Dan
Rosindell, Andrew
Russell, Bob
Sanders, Mr. Adrian
Scott, Mr. Lee
Selous, Andrew
Shapps, Grant
Simmonds, Mark
Simpson, Mr. Keith
Smith, Sir Robert
Soames, Mr. Nicholas
Spicer, Sir Michael
Spink, Bob
Spring, Mr. Richard
Steen, Mr. Anthony
Streeter, Mr. Gary
Stunell, Andrew
Swayne, Mr. Desmond
Swire, Mr. Hugo
Syms, Mr. Robert
Tapsell, Sir Peter
Taylor, Mr. Ian
Thurso, John
Timpson, Mr. Edward
Tredinnick, David
Turner, Mr. Andrew
Tyrie, Mr. Andrew
Vaizey, Mr. Edward
Vara, Mr. Shailesh
Viggers, Sir Peter
Villiers, Mrs. Theresa
Walker, Mr. Charles
Wallace, Mr. Ben
Waterson, Mr. Nigel
Watkinson, Angela
Whittingdale, Mr. John
Widdecombe, rh Miss Ann
Williams, Mark
Williams, Mr. Roger
Willott, Jenny
Wilson, Mr. Rob
Winterton, Ann
Winterton, Sir Nicholas

Wright, Jeremy
Yeo, Mr. Tim
Younger-Ross, Richard
Tellers for the Ayes:

Mr. Stephen Crabb and
Bill Wiggin

Abbott, Ms Diane
Allen, Mr. Graham
Anderson, Mr. David
Anderson, Janet
Armstrong, rh Hilary
Atkins, Charlotte
Austin, Mr. Ian
Bailey, Mr. Adrian
Bain, Mr. William
Baird, Vera
Balls, rh Ed
Banks, Gordon
Barron, rh Mr. Kevin
Battle, rh John
Bayley, Hugh
Beckett, rh Margaret
Begg, Miss Anne
Benton, Mr. Joe
Berry, Roger
Betts, Mr. Clive
Blackman, Liz
Blackman-Woods, Dr. Roberta
Blears, rh Hazel
Blizzard, Mr. Bob
Blunkett, rh Mr. David
Borrow, Mr. David S.
Bradshaw, rh Mr. Ben
Brennan, Kevin
Brown, Lyn
Brown, rh Mr. Nicholas
Brown, Mr. Russell
Burden, Richard
Burgon, Colin
Burnham, rh Andy
Butler, Ms Dawn
Byers, rh Mr. Stephen
Caborn, rh Mr. Richard
Cairns, David
Campbell, Mr. Alan
Campbell, Mr. Ronnie
Caton, Mr. Martin
Challen, Colin
Chapman, Ben
Clapham, Mr. Michael
Clark, Ms Katy
Clark, Paul
Clarke, rh Mr. Charles
Clarke, rh Mr. Tom
Clelland, Mr. David
Clwyd, rh Ann
Coaker, Mr. Vernon
Coffey, Ann
Connarty, Michael
Cooper, rh Yvette
Corbyn, Jeremy
Cousins, Jim
Crausby, Mr. David
Creagh, Mary
Cryer, Mrs. Ann
Cummings, John
Cunningham, Mr. Jim
Cunningham, Tony
Darling, rh Mr. Alistair
David, Mr. Wayne
Davidson, Mr. Ian
Davies, Mr. Dai
Davies, Mr. Quentin
Dean, Mrs. Janet
Denham, rh Mr. John
Dhanda, Mr. Parmjit
Dismore, Mr. Andrew
Dobbin, Jim
Donohoe, Mr. Brian H.
Doran, Mr. Frank
Dowd, Jim
Drew, Mr. David
Eagle, Angela
Efford, Clive
Ellman, Mrs. Louise
Engel, Natascha
Ennis, Jeff
Farrelly, Paul
Field, rh Mr. Frank
Fitzpatrick, Jim
Flello, Mr. Robert
Flint, rh Caroline
Foster, Michael Jabez (Hastings and Rye)
Francis, Dr. Hywel
Gapes, Mike
Gardiner, Barry
George, rh Mr. Bruce
Gerrard, Mr. Neil
Gilroy, Linda
Godsiff, Mr. Roger
Goodman, Helen
Griffith, Nia
Griffiths, Nigel
Grogan, Mr. John
Hall, Patrick
Hamilton, Mr. Fabian
Hanson, rh Mr. David
Harman, rh Ms Harriet
Harris, Mr. Tom
Havard, Mr. Dai
Healey, rh John
Hendrick, Mr. Mark
Heppell, Mr. John
Hesford, Stephen
Hewitt, rh Ms Patricia
Heyes, David
Hillier, Meg
Hodge, rh Margaret
Hoey, Kate
Hoon, rh Mr. Geoffrey
Hope, Phil
Hopkins, Kelvin
Howarth, rh Mr. George
Howells, rh Dr. Kim
Hoyle, Mr. Lindsay
Hughes, rh Beverley
Humble, Mrs. Joan
Hutton, rh Mr. John
Iddon, Dr. Brian
Illsley, Mr. Eric
Irranca-Davies, Huw
James, Mrs. Siân C.
Jenkins, Mr. Brian
Johnson, rh Alan
Johnson, Ms Diana R.

Jones, Helen
Jones, Lynne
Jones, Mr. Martyn
Joyce, Mr. Eric
Kaufman, rh Sir Gerald
Keeley, Barbara
Keen, Alan
Keen, Ann
Kelly, rh Ruth
Kemp, Mr. Fraser
Kidney, Mr. David
Kilfoyle, Mr. Peter
Knight, rh Jim
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Lammy, rh Mr. David
Lazarowicz, Mark
Lepper, David
Levitt, Tom
Lewis, Mr. Ivan
Lloyd, Tony
Love, Mr. Andrew
Lucas, Ian
Mackinlay, Andrew
Mactaggart, Fiona
Mahmood, Mr. Khalid
Mallaber, Judy
Mann, John
Marris, Rob
Marsden, Mr. Gordon
Marshall-Andrews, Mr. Robert
Martlew, Mr. Eric
McAvoy, rh Mr. Thomas
McCarthy, Kerry
McCarthy-Fry, Sarah
McDonagh, Siobhain
McDonnell, John
McFadden, rh Mr. Pat
McFall, rh John
McGovern, Mr. Jim
McGuire, rh Mrs. Anne
McIsaac, Shona
McKechin, Ann
McNulty, rh Mr. Tony
Meacher, rh Mr. Michael
Merron, Gillian
Michael, rh Alun
Miliband, rh Edward
Miller, Andrew
Mitchell, Mr. Austin
Moffat, Anne
Moffatt, Laura
Mole, Chris
Moon, Mrs. Madeleine
Morden, Jessica
Morgan, Julie
Morley, rh Mr. Elliot
Mudie, Mr. George
Mullin, Mr. Chris
Munn, Meg
Murphy, rh Mr. Jim
Murphy, rh Mr. Paul
Naysmith, Dr. Doug
O'Brien, rh Mr. Mike
Olner, Mr. Bill
Osborne, Sandra
Owen, Albert
Palmer, Dr. Nick
Pearson, Ian
Plaskitt, Mr. James
Pope, Mr. Greg
Prentice, Bridget
Prentice, Mr. Gordon
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Mr. Ken
Purnell, rh James
Raynsford, rh Mr. Nick
Reed, Mr. Andy
Reed, Mr. Jamie
Riordan, Mrs. Linda
Robinson, Mr. Geoffrey
Rooney, Mr. Terry
Roy, Mr. Frank
Roy, Lindsay
Ruane, Chris
Ruddock, Joan
Russell, Christine
Salter, Martin
Seabeck, Alison
Sharma, Mr. Virendra
Shaw, Jonathan
Sheridan, Jim
Simon, Mr. Siôn
Simpson, Alan
Skinner, Mr. Dennis
Slaughter, Mr. Andy
Smith, rh Mr. Andrew
Smith, Ms Angela C. (Sheffield, Hillsborough)
Smith, rh Angela E. (Basildon)
Smith, Geraldine
Smith, rh Jacqui
Snelgrove, Anne
Soulsby, Sir Peter
Spellar, rh Mr. John
Starkey, Dr. Phyllis
Stewart, Ian
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Straw, rh Mr. Jack
Stuart, Ms Gisela
Sutcliffe, Mr. Gerry
Tami, Mark
Taylor, Ms Dari
Taylor, Dr. Richard
Thomas, Mr. Gareth
Thornberry, Emily
Todd, Mr. Mark
Touhig, rh Mr. Don
Trickett, Jon
Truswell, Mr. Paul
Turner, Dr. Desmond
Turner, Mr. Neil
Twigg, Derek
Ward, Claire
Wareing, Mr. Robert N.
Watson, Mr. Tom
Watts, Mr. Dave
Whitehead, Dr. Alan
Wicks, rh Malcolm
Williams, Mrs. Betty
Wills, rh Mr. Michael
Wilson, Phil
Winnick, Mr. David
Winterton, rh Ms Rosie
Wright, Mr. Anthony
Wright, David
Wright, Dr. Tony
Tellers for the Noes:

Steve McCabe and
Mrs. Sharon Hodgson

Question accordingly negatived.
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Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

Question agreed to.

Main Question, as amended, put and agreed to.


    That this House supports family doctors as the bedrock of healthcare services in the NHS; welcomes the improvements in out-of-hours and urgent care services over the last 12 years; notes that the Carson report in 2000 identified the need for the reform of out-of-hours care which was carried out in 2004; further notes that by the start of 2004 only five per cent. of patients saw their own GP out of hours; acknowledges that GP organisations say that they do not want a return to the system which existed in 1997; understands the continuing need to improve the quality of out-of-hours care; notes that the Government commissioned the first national out-of-hours benchmark to help primary care trusts and providers improve the quality and productivity of out-of-hours services and to reduce local variation; recognises the improvement in healthcare after the introduction of the GP contract in 2004, which has significantly extended weekend and evening opening of surgeries for routine, bookable appointments; recognises that over 77 per cent. of GP practices now offer extended opening hours and that every primary care trust is developing a new GP-led health centre, open from 8 am until 8 pm, seven days a week, 365 days a year; and welcomes plans for people who need urgent care to be able to dial 111 for advice 24 hours a day, seven days a week.

Business without Debate

Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Road Traffic

    That the draft Motor Vehicles (International Circulation) (Amendment) Order 2010,which was laid before this House on 5 January, be approved. - (Helen Jones .)

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),


    That the draft Overhead Lines (Exempt Installations) Order 2010, which was laid before this House on 6 January, be approved. - (Helen Jones .)

Question agreed to.

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